The proposal, entitled "Reducing Ethnic and Racial Bias in Screening for Psychiatric Disorders in Adolescents" is designed to improve the effectiveness of identification, referral and screening for mental health disorders potentially associated with ethnic/racial disparities in adolescents'receipt of mental health care. For racial and ethnic minority youth, there is a great disparity in the receipt of mental health services and, as a result, these youth are more likely to experience persistent impairment from psychiatric disorders. Preliminary data on referrals for mental health treatment appear to indicate that minority children are under-identified for services by their schools and families, the two major referral sources. The research to be generated can help us achieve needed enhancement in school screening, a previously under-funded area of health services research in general, and comparative effectiveness research more specifically. This project provides the opportunity to support the analysis and dissemination of data from the National Comorbidity Survey Adolescent Supplement (NCS-A), the most comprehensive national data available to study screening and referral patterns for ethnic/racial minority children. We propose four specific aims that allow us to examine a broad range of possible causes for under- recognition and lack of treatment for ethic and racial minority youth as well as alternative methods for enhancing screening tools used to assess them. Aim 1 intends to determine whether schools are equally likely to encourage parents of ethnic/racial minority youth who have psychiatric disorders to seek services for their child as they are to encourage non-Latino white parents, and whether school, community, and family characteristics explain any disparities in referral. Aim 2 then tries to identify ethnic/racial differences in parents'assessment of youth with psychiatric disorders associated with ethnic/racial disparities in service access. Aim 3 plans to evaluate meaning and response bias in the screening questions used to assess major depression and generalized anxiety disorders in non-Latino white and racial/ethnic minority adolescents. Finally in Aim 4, we compare the accuracy of predictions of mood and anxiety disorders using screening scales specific to blacks, to Latinos or to whites, with universalistic screening scales, in order to help improve detection for ethnic and racial minorities, and to determine if the scales should be group-specific or universal. Study results will be distilled to provide basic information about biases in the identification, referral and screening process by schools, and factors that influence whether parents identify "mental health problems" and follow-up on service referrals. Findings will be disseminated through a website for teachers and school mental health service providers, via newsletters of professional organizations, and by submission to annual conventions of school- based practitioners, thus bringing critical information to those most poised to affect change. The proposed research is designed to improve the effectiveness of identification, referral and screening for mental health disorders potentially associated with ethnic/racial disparities in adolescent receipt of mental health care. Using data from the National Comorbidity Survey Adolescent Supplement (NCS-A), the most comprehensive national data available to study screening and referral patterns for ethnic/racial minority children, we propose four specific aims that allow us to examine a broad range of possible causes for under- recognition and lack of treatment for ethic and racial minority youth as well as alternative methods for enhancing screening tools used to assess them. The project intends to distill and disseminate research results to those most poised to affect change, including creating a list of basic information about biases in the identification, referral and screening process by schools, and factors that influence whether parents identify "mental health problems" and follow-up on referrals for services, thus working towards the goal of diminishing the impact of early onset disorders and preventing the development of comorbid and more serious mental health problems.